Well, Mr. Beauregard, let me respond to your questions.
1) Those quotations where meant for paraphrasing. It is completely acceptable to use quotations when framing a paraphrase. But thank you for the hip-pocket english lesson. What I was referring to was your ability to draw conclusions based on little or no evidence. Your response to me was 80% assumption based on...what exactly? Let me list them.
a) "Just because you share an office with a battalion surgeon does not mean you know anything about the practice of medicine." (That was a good one, warmed my heart, but I think claiming that I don't know ANYTHING about the practice of medicine, even though I work along side doctors daily and are expected to do EVERYTHING while my MD just looks over my shoulder and my notes [yes, this includes minor surgical procedures, SOAPs, and research] may be overreaching, but I suppose that, since you believe that people that don't attend medical school should not proclaim to know ANYTHING about medicine, this won't amount to much either.)
b) "As such, part of the difficulty here is that we future physicians work so hard to learn all we can in order to properly treat and care for our patients, while these nurses, who are not educated in the intricacies of the human body, want to claim they are equally trained and thus can practice equally." (Nurses, even at the post-bacc level, are not educated in the intricacies of the human body? Truely? I would have agreed that the DEPTH in which they are trained is not equal to that of a physician, but not educated at all, hm? I would whole-heartedly disagree. Perhaps you should ask your NP school friends. I suppose that all they learn at graduate level nursing is just a better way to start an I.V. or the science of no-sodium food trays.)
c) "Again, this illustrates your ignorance to the subject. Do you realize how difficult it is to adequately manage "low-grade hypertension" (I have yet to see low-grade as a classification for hypertension in any text, which further proves my point). I bet you also think it's pretty easy to manage diabetes, don't you?" (Woops, I meant stage I hypertension there. My apologies. Didn't mean to let my ignorance hang out there by giving it the wrong adjective. And come on, man, managing certain levels of hypertension and certain types of diabetes is not THAT bloody difficult. You do the studies, figure out the why, then treat the why. When you are learning about it while you are in the weeds, I suppose that it would seem daunting, but in actual practice? I would think not.)
d) "You have obviously never worked with a primary care physician, because much of what you see will not be "owwy, I pulled a butt muscle". (Oh yes, obviously I never worked with a primary care physician, hahahahaha. Oh man, that's good stuff. That was a genuine laugh there. And the "owwy, I pulled a butt muscle" was my attempt at humor. I think you would be shocked how much time I spent with FP physicians, both on the clock and off, and how much of my work in the military has been FP related. But I don't like to toot my own horn.)
e) "Much of it is hypertension; non-compliant type 2 diabetics with resulting diabetic nephropathy and CKD, peripheral neuropathy and retinopathy; those with NYHA Stage 3 congestive heart failure; those with significant PAD/PVD; etc. It's really easy for you to say that those can be taken care of by the NP, let the docs manage the hard stuff. But you see, this is the hard stuff." (I agree, since most diabetes, treated early enough, doesn't result in diabetic nephropathy, CKD, peripheral neuropathy and retinopathy. That is at a pretty advanced stage, where the viscosity of the blood destroys the blood vessels and causes those systems to fail. When caught and managed early enough, the patient shouldn't see significant eye and nerve damage, but what do I know? Stage 3 hypertension, is that the majority of complaints the average FP doctor will run into? I am AA, I have lived with high systolic values for the better part of my adult life. I can run 3mi in 18mins, I am 16% body fat, don't eat fatty foods, low LDLs, and work out everyday. Would you reckon my BP is hard to manage?)
f) "This role should not, however, be one of independent practice, and this is the issue. Physicians needs to be there to supervise, and that's that." (Ah, and there it is. No one can practice medicine unless you are a doctor. I mean, how did we get by without such loftly professionals? How do people in rural areas live without doctors? Most physicians are not willing to practice in the inner-city, out in the boondocks, or in isolated communities where the pay won't put a dent in your student loan bills, so I guess these people are ass out of luck. I mean, really, what would a DNP be thinking, bringing affordable healthcare to the less fortunate, or sharing some of the load of, yes, EASY medicine. Let them be, I think they can manage without your big, sexy brain.)
g) "You scare me. You know why? Because you are willing to let an unequally trained NP/DNP enter the room of an unsuspecting patient and attempt to treat independently. And when something goes wrong, just let the system take care of it. You have shown a blatant disregard for any patient's well-being that you allow this to happen to. Good job, sir." (Now that one hurt. Not only did you call me uncaring, which my track record would certainly dispprove, but you make it sound like I am willing to unleash the unholy hounds of inadequency upon the unsuspecting townspeople. Number one, the patient knows if he/she is dealing with a nurse or a doctor, they are not stupid. Number two, "the system?" Really? When did I become a broker of "the system?" Is your regard for anyone that did not attend medical school SO low that you think that anyone that doesn't have MD/DO behind their name will do nothing to benefit or improve the patient's condition? Who kills more patients in hospital settings? Who covers who's ass day to day? And they don't, by and large, "attempt" to provide quality healthcare, they provide quality healthcare. They have a scope of practice, and unlike MANY physicians I know, they know their limits. If something exceeds them, they call in a doctor, much like when a primary care physician gets smoked by a difficult case, they consult and refer. The DNPs are not attempting to perform surgery, man. And I think the ones that are showing "a blantant disregard for the patient's well-being" are the ones that allow a broken system to remain broken for the sake of one's ego. Physicians are not the end all to medicine. Your ego scares me, medi-pup.
2) So you have more room to speak of these things because you are a medical student? Interesting. I suppose that I shouldn't have any room to speak of medicine because I am not a medical student yet, please excuse me for having an opinion and asking questions. I suppose years of experience in clinical environments ranging from hospitals to clinics to Aid stations, as well as years of experience being the sole medical provider for a company of Marines both in garrison and during deployment shouldn't really amount to much. I mean, hey, you are the guy with the book and sitting in the lectures, SURELY you know more about these things then I do. I apologize for questioning your obvious superiority.
especially since three shrinks have me covering their patients today.
I think what Valadi meant was that you can gain additional knowledge in med school and still treat patients.
